Abstract
Background
Unhealthy lifestyle is a major risk factor for coronary heart disease, which may be explained by elevated remnant cholesterol. However, this question remains incompletely clarified. In this study, we aimed to investigate whether elevated remnant cholesterol explains part of the excess risk of myocardial infarction and coronary heart disease in individuals with unhealthy lifestyle.
Methods
We included 104,867 individuals (58,286 women and 46,581 men) from the Copenhagen General Population Study free from coronary heart disease at examination. During a median follow-up of 9.2 years, 2484 developed myocardial infarction and 3570 developed coronary heart disease. To understand explained risk from elevated remnant cholesterol due to unhealthy lifestyle on risk of myocardial infarction and coronary heart disease, we used mediation analyses.
Findings
Current smoking, low physical activity, and low adherence to dietary guidelines were all associated with higher levels of remnant cholesterol. For current smoking, remnant cholesterol explained 15% (95% confidence interval: 9.7%–20%) of the excess risk of myocardial infarction and 16% (11%–21%) of the excess risk of coronary heart disease. Corresponding values for low physical activity were 20% (13%–27%) and 21% (15%–28%), and for low adherence to dietary guidelines 12% (6.6%–18%) and 14% (8.0%–19%), respectively. Results were similar in women and men separately and in analyses where each lifestyle factor were additionally adjusted for the other three lifestyle factors.
Interpretation
Elevated remnant cholesterol explained part of excess myocardial infarction and coronary heart disease in individuals with an unhealthy lifestyle. Clinically, these novel findings underline the importance of both elevated remnant cholesterol and promotion of healthy lifestyle in primary prevention of myocardial infarction and coronary heart disease.
Funding
Independent Research Fund Denmark; Johan Boserup and Lise Boserups Grant; Medical Research Council.
Unhealthy lifestyle is a major risk factor for coronary heart disease, which may be explained by elevated remnant cholesterol. However, this question remains incompletely clarified. In this study, we aimed to investigate whether elevated remnant cholesterol explains part of the excess risk of myocardial infarction and coronary heart disease in individuals with unhealthy lifestyle.
Methods
We included 104,867 individuals (58,286 women and 46,581 men) from the Copenhagen General Population Study free from coronary heart disease at examination. During a median follow-up of 9.2 years, 2484 developed myocardial infarction and 3570 developed coronary heart disease. To understand explained risk from elevated remnant cholesterol due to unhealthy lifestyle on risk of myocardial infarction and coronary heart disease, we used mediation analyses.
Findings
Current smoking, low physical activity, and low adherence to dietary guidelines were all associated with higher levels of remnant cholesterol. For current smoking, remnant cholesterol explained 15% (95% confidence interval: 9.7%–20%) of the excess risk of myocardial infarction and 16% (11%–21%) of the excess risk of coronary heart disease. Corresponding values for low physical activity were 20% (13%–27%) and 21% (15%–28%), and for low adherence to dietary guidelines 12% (6.6%–18%) and 14% (8.0%–19%), respectively. Results were similar in women and men separately and in analyses where each lifestyle factor were additionally adjusted for the other three lifestyle factors.
Interpretation
Elevated remnant cholesterol explained part of excess myocardial infarction and coronary heart disease in individuals with an unhealthy lifestyle. Clinically, these novel findings underline the importance of both elevated remnant cholesterol and promotion of healthy lifestyle in primary prevention of myocardial infarction and coronary heart disease.
Funding
Independent Research Fund Denmark; Johan Boserup and Lise Boserups Grant; Medical Research Council.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | 101223 |
| Tidsskrift | The Lancet Regional Health - Europe |
| ISSN | 2666-7762 |
| DOI | |
| Status | E-pub ahead of print - 2025 |
Bibliografisk note
Funding Information:Independent Research Fund Denmark; Johan Boserup and Lise Boserups Grant; Medical Research Council.The authors thank staff and participants of the Copenhagen General Population Study for their important contributions. The study was funded by the Independent Research Fund, Denmark [grantno: 9039-00360B to BGN], and by Johan Boserup and Lise Boserups Grant [grant no: 20795-24 to M\u00D8J]. George Davey Smith and NMR processing costs were supported by the Medical Research Council Integrative Epidemiology Unit at the University of Bristol MC_UU_00032. Funders had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the paper for publication. All authors had access to all data and had final responsibility for the decision to submit for publication.
Funding Information:
The study was funded by the Independent Research Fund, Denmark [grantno:9039-00360B to BGN], and by Johan Boserup and Lise Boserups Grant [grant no: 20795-24 to M\u00D8J]. George Davey Smith and NMR processing costs were supported by the Medical Research Council Integrative Epidemiology Unit at the University of Bristol MC_UU_00032. Funders had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the paper for publication.
Funding Information:
The authors thank staff and participants of the Copenhagen General Population Study for their important contributions. The study was funded by the Independent Research Fund, Denmark [grantno:9039-00360B to BGN], and by Johan Boserup and Lise Boserups Grant [grant no: 20795-24 to M\u00D8J]. George Davey Smith and NMR processing costs were supported by the Medical Research Council Integrative Epidemiology Unit at the University of Bristol MC_UU_00032. Funders had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the paper for publication. All authors had access to all data and had final responsibility for the decision to submit for publication.
Publisher Copyright:
© 2025 The Author(s)